Spousal Mourning for Partners Living with Cognitive Impairment: The Interplay of Attachment and the Two-Track Model of Dementia Grief

Abstract

The aim of the present research was to study the interplay of Attachment Theory and the Two-Track Model of Dementia Grief. To examine the research hypotheses, a cross-sectional study was designed and included 122 participants (Mean age = 72.77) drawn from four groups: spouses of people living with mild to moderate cognitive impairment, spouses of people living with advanced cognitive impairment, widowed spouses of deceased dementia patients, and a control group. Participants completed a battery of self-report questionnaires. Results showed that secure attachment constitutes a significant protective factor with regard to bio-psycho-social symptomatology (Track I) as well as difficulties in the relational bond with the spouse and grief over their deterioration (Track II). The results of the research support integrating attachment-based insights into clinical work with spouses coping with the losses accompanying cognitive decline and the grief processes that are operant in these losses.

Keywords

attachment dementia loss grief bereavement two-track model

Get full access to this article

View all access options for this article.

References

Adams

K. B.

Sanders

(2004). Alzheimer’s caregiver differences in experience of loss, grief reactions and depressive symptoms across stage of disease: A mixed-method analysis. Dementia, 3(2), 195–210. https://doi.org/10.1177/1471301204042337

Adres

(2011). Attachment and the two-track model of bereavement in parent loss: The contribution of the relationships with spouse, a living child, and “god” to outcome. Haifa, Israel: University of Haifa. Unpublished doctoral dissertation(Hebrew).

American Psychiatric Association . (2013). Diagnostic and statistiacal manual of mental disorders (5th ed.). Arlington: American Psychiatric Association.

Aron

E. N.

Smollan

(1992). Inclusion of other in the self scale and the structure of interpersonal closeness. Journal of Personality and Social Psychology, 63(4), 596–612. https://doi.org/10.1037/0022-3514.63.4.596

Bartholomew

Horowitz

L. M.

(1991). Attachment styles among young adults: A test of a four-category model. Journal of Personality and Social Psychology, 61(2), 226–244.‏ https://doi.org/10.1037/0022-3514.61.2.226

Blandin

Pepin

(2017). Dementia grief: A theoretical model of a unique grief experience. Dementia, 16(1), 67–78. https://doi.org/10.1177/1471301215581081

Blatt

S. J.

Levy

K. N.

(2003). Attachment theory, psychoanalysis, personality development, and psychopathology. Psychoanalytic Inquiry, 23(1), 102–150. https://doi.org/10.1080/07351692309349028

Blieszner

Roberto

K. A.

Wilcox

K. L.

Barham

E. J.

Winston

B. L.

(2007). Dimensions of ambiguous loss in couples coping with mild cognitive impairment. Family Relations, 56(2), 196–209. https://doi.org/10.1111/j.1741-3729.2007.00452.x

Bodner

Cohen-Fridel

(2010). Relations between attachment styles, ageism and quality of life in late life. International Psychogeriatrics, 22(8), 1353–1361. https://doi.org/10.1017/S1041610210001249

10.

Boss

(2010). The trauma and complicated grief of ambiguous loss. Pastoral Psychology, 59(2), 137–145. https://doi.org/10.1007/s11089-009-0264-0

11.

Bowlby

(1980). Attachment and loss. In: Loss, sadness and depression (Vol. 3). New York: Basic Books.

12.

Brennan

K. A.

Clark

C. L.

Shaver

P. R.

(1998). Self-report measurement of adult attachment: An integrative overview. In Simpson

J. A.

Rholes

W. S.

(Eds), Attachment theory and close relationships (pp. 46–76). New York: Guilford Press.

13.

Bretherton

(1992). The origins of attachment theory: John Bowlby and mary ainsworth. Developmental Psychology, 28(5), 759–775.‏ https://doi.org/10.1037/0012-1649.28.5.759

14.

Burke

L. A.

Neimeyer

R. A.

(2013). Prospective risk factors for complicated grief: A review of the empirical literature. In Stroebe

Schut

Boelen

Van den Bout

(Eds), Complicated grief: Scientific foundations for health care professionals (pp. 145–161). Washington, DC: American Psychological Association.

15.

Cassidy

Shaver

P. R.

(Eds), (2016). Theory, research, and clinical applications. In: Handbook of attachment. (third edition). New York: Guilford Press.

16.

Champlin

B. E.

(2020). The informal caregiver’s lived experience of being present with a patient who receives a diagnosis of dementia: A phenomenological inquiry. Dementia, 19(2), 375–396. https://doi.org/10.1177/1471301218776780

17.

Cheung

D. S. K.

K. H. M.

Cheung

T. F.

Lam

S. C.

Tse

M. M. Y.

(2018). Anticipatory grief of spousal and adult children caregivers of people with dementia. BMC Palliative Care, 17(1), 1–10. https://doi.org/10.1186/s12904-018-0376-3

18.

Cohen-Levinson

. (2004). The impact of informal social support on successful aging of people with mental retardation. Unpublished master’s thesis. Haifa, Israel. (Hebrew): University of Haifa.

19.

Corey

K. L.

McCurry

M. K.

(2018). When caregiving ends: The experiences of former family caregivers of people with dementia. The Gerontologist, 58(2), Article e87-e96.‏ https://doi.org/10.1093/geront/gnw205

20.

Crespo

Piccini

A. T.

Bernaldo-de-Quirós

(2013). When the care ends: Emotional state of Spanish bereaved caregivers of persons with dementia. The Spanish Journal of Psychology, 16(e97), 1–8. https://doi.org/10.1017/sjp.2013.97

21.

Doka

K. J.

(2010). Grief, multiple loss and dementia. Bereavement Care, 29(3), 15-20. https://doi.org/10.1080/02682621.2010.522374.

22.

Field

Filanosky

(2009). Continuing bonds, risk factors for complicated grief, and adjustment to bereavement. Death Studies, 34(1), 1–29. https://doi.org/10.1080/07481180903372269

23.

Fiori

K. L.

Consedine

N. S.

Merz

E. M.

(2011). Attachment, social network size, and patterns of social exchange in later life. Research on Aging, 33(4), 465–493. https://doi.org/10.1177/0164027511401038

24.

Fonagy

(2018). Attachment theory and psychoanalysis. New York: Routledge.

25.

Garand

Lingler

J. H.

Deardorf

K. E.

DeKosky

S. T.

Schulz

Reynolds

C. F.,

III Dew

M. A.

(2012). Anticipatory grief in new family caregivers of persons with mild cognitive impairment and dementia. Alzheimer Disease and Associated Disorders, 26(2), 159–165. https://doi.org/10.1097/WAD.0b013e31822f9051

26.

Givens

J. L.

Prigerson

H. G.

Kiely

D. K.

Shaffer

M. L.

Mitchell

S. L.

(2011). Grief among family members of nursing home residents with advanced dementia. The American Journal of Geriatric Psychiatry, 19(6), 543–550. https://doi.org/10.1097/JGP.0b013e31820dcbe0

27.

Hazan

Shaver

P. R.

(1987). Romantic love conceptualized as an attachment process. Journal of Personality and Social Psychology, 52(3), 511–524.‏ https://doi.org/10.1037/0022-3514.52.3.511

28.

Hendrick

S. S.

(1988). A generic measure of relationship satisfaction. Journal of Marriage and the Family, 50(1), 93–98. https://doi.org/10.2307/352430

29.

Holley

C. K.

Mast

B. T.

(2009). The impact of anticipatory grief on caregiver burden in dementia caregivers. The Gerontologist, 49(3), 388–396. https://doi.org/10.1093/geront/gnp061

30.

Karantzas

G. C.

Romano

Lee

(2019). Attachment and aged care: A systematic review of current research. Current Opinion in Psychology, 25(1), 37–46. https://doi.org/10.1016/j.copsyc.2018.02.016

31.

Klass

Silverman

Nickman

(Eds), (1996). Continuing bonds: New understandings of grief. Washington, DC: Taylor & Francis.

32.

Klass

Steffen

E. M.

(Eds), (2018). Continuing bonds in bereavement: New directions for research and practice. New York: Taylor & FrancisRoutledge.

33.

Kohout

F. J.

Berkman

L. F.

Evans

D. A.

Cornoni-Huntley

(1993). Two shorter forms of the CES-D depression symptoms index. Journal of Aging and Health, 5(2), 179–193. https://doi.org/10.1177/089826439300500202

34.

Kosminsky

P. S.

Jordan

J. R.

(2016). Attachment-informed grief therapy: The clinician’s guide to foundations and applications. New York: Routledge.

35.

Levi-Belz

Lev-Ari

(2019). Is there anybody out there? Attachment style and interpersonal facilitators as protective factors against complicated grief among suicide-loss survivors. The Journal of Nervous and Mental Disease, 207(3), 131–136.‏ https://doi.org/10.1097/NMD.0000000000000940

36.

Manevich

Rubin

S. S.

Katz

Ben-Hayun

Aharon-Peretz

(2022). The Two-Track Model of Dementia Grief and spousal response to illness and death. Death Studies. Online ahead of print. https://doi.org/10.1080/07481187.2022.2113479

37.

Meier

A. M.

Carr

D. R.

Currier

J. M.

Neimeyer

R. A.

(2013). Attachment anxiety and avoidance in coping with bereavement: Two studies. Journal of Social and Clinical Psychology, 32(3), 315–334. https://doi.org/10.1521/jscp.2013.32.3.315

38.

Meuser

T. M.

Marwit

S. J.

(2001). A comprehensive, stage-sensitive model of grief in dementia caregiving. The Gerontologist, 41(5), 658–670. https://doi.org/10.1093/geront/41.5.658

39.

Mikulincer

Shaver

P. R.

(2008). An attachment perspective on bereavement. In Stroebe

M. S.

Hansson

R. O.

Schut

Stroebe

(Eds), Handbook of bereavement research and practice: Advances in theory and intervention (pp. 87–112). Washington, DC: American Psychological Association.

40.

Monin

J. K.

Schulz

Kershaw

T. S.

(2013). Caregiving spouses’ attachment orientations and the physical and psychological health of individuals with Alzheimer's disease. Aging and Mental Health, 17(4), 508–516. https://doi.org/10.1080/13607863.2012.747080

41.

Neimeyer

R. A.

Holland

J. M.

(2015). Bereavement in later life: Theory, assessment and intervention. In Mast

B. T.

Lichtenberg

P. A.

(Eds), Handbook of clinical geropsychology. Washington, DC: American Psychological Association.

42.

Nelis

S. M.

Clare

Whitaker

C. J.

(2014). Attachment in people with dementia and their caregivers: A systematic review. Dementia, 13(6), 747–767. https://doi.org/10.1177/1471301213485232

43.

Nielsen

M. K.

Neergaard

M. A.

Jensen

A. B.

Bro

Guldin

M. B.

(2016). Do we need to change our understanding of anticipatory grief in caregivers? A systematic review of caregiver studies during end-of-life caregiving and bereavement. Clinical Psychology Review, 44, 75–93. https://doi.org/10.1016/j.cpr.2016.01.002

44.

Noyes

B. B.

Hill

R. D.

Hicken

B. L.

Luptak

Rupper

Dailey

N. K.

Bair

B. D.

(2010). The role of grief in dementia caregiving. American Journal of Alzheimer's Disease and Other Dementias, 25(1), 9–17. https://doi.org/10.1177/1533317509333902

45.

Peacock

Bayly

Gibson

Holtslander

Thompson

O’Connell

(2018). The bereavement experience of spousal caregivers to persons with dementia: Reclaiming self. Dementia, 17(1), 78–95.‏ https://doi.org/10.1177/1471301216633325

46.

Perren

Schmid

Herrmann

Wettstein

(2007). The impact of attachment on dementia-related problem behavior and spousal caregivers' well-being. Attachment and Human Development, 9(2), 163–178. https://doi.org/10.1080/14616730701349630

47.

Pote

(2016). The moderating effect of anticipatory grief on the relationship between attachment and perceived closeness with satisfaction of life and marriage for spousal caregivers of individuals with dementia. Colorado, USA: Unpublished doctoral dissertation, University of Northern Colorado.

48.

Prizant

(2000). Promoting empowering processes for the elderly with disabilities. Haifa, Israel: University of Haifa. Unpublished master’s thesis(Hebrew).

49.

Radloff

L. S.

(1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1(3), 385–401. https://doi.org/10.1177/014662167700100306

50.

Rando

T. A.

(1986). Loss and anticipatory grief. Lexington, MA: Lexington Books.

51.

Rubin

(1981). A two-track model of bereavement: Theory and application in research. American Journal of Orthopsychiatry, 51(1), 101–109. https://doi.org/10.1111/j.19390025.1981.tb01352.x

52.

Rubin

S. S.

(1999). The two-track model of bereavement: Overview, retrospect, and prospect. Death Studies, 23(8), 681–714. https://doi.org/10.1080/074811899200731

53.

Rubin

S. S.

Bar-Nadav

(2016). The two-track model of bereavement questionnaire for complicated grief (TTBQ-CG31). In Neimeyer

R. A.

(Ed), Techniques of grief therapy: Assessment and intervention (pp. 87–98). New York: Routledge.

54.

Rubin

S. S.

Malkinson

Witztum

(2012). Working with the bereaved: Multiple lenses on loss and mourning. New York: Taylor & FrancisRoutledge.

55.

Rubin

S. S.

Malkinson

Witztum

(2020). Traumatic bereavements: Rebalancing the relationship to the deceased and the death story using the Two-Track Model of Bereavement. Frontiers in Psychiatry, 11, 537596. https://doi.org/10.3389/fpsyt.2020.537596

56.

Rubin

S. S.

Manevich

Doron

I., I.

(2021). The Two-Track Model of Dementia Grief (TTM-DG): The theoretical and clinical significance of the continuing bond in sickness and in death. Death Studies, 45(10), 755–771. https://doi.org/10.1080/07481187.2019.1688014

57.

Scholtes

Browne

(2015). Internalized and externalized continuing bonds in bereaved parents: Their relationship with grief intensity and personal growth. Death Studies, 39(2), 75–83. https://doi.org/10.1080/07481187.2014.890680

58.

Spanier

G. B.

(1976). Measuring dyadic adjustment: New scales for assessing the quality of marriage and similar dyads. Journal of Marriage and the Family, 38, 15–28. https://doi.org/10.2307/350547

59.

Wei

Russell

D. W.

Mallinckrodt

Vogel

D. L.

(2007). The experiences in close relationship scale (ECR)-short form: Reliability, validity, and factor structure. Journal of Personality Assessment, 88(2), 187–204. https://doi.org/10.1080/00223890701268041

60.

Schoebi

Wang

(2015). Growing in times of grief: Attachment modulates bereaved adults' posttraumatic growth after losing a family member to cancer. Psychiatry Research, 230(1), 108–115. https://doi.org/10.1016/j.psychres.2015.08.035

61.

Yehene

Manevich

Rubin

S. S.

(2021). Caregivers` grief in acquired non-death interpersonal loss (NoDIL): A process based model with implications for theory, research and intervention. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.676536

62.

Yehene

Zaksh

Davidian

Bar-Nadav

Elyashiv

(2019). Locked-in your heart-shaped box: Familial-role and attachment orientation as predictors of grief in prolonged disorders of consciousness vs. death. Death Studies, 44(8), 510–520. https://doi.org/10.1080/07481187.2019.1586795